This condition is considered a syndrome of chronic muscle pain associated with a neurohormonal dysfunction of the autonomic nervous system. Individuals with this systemic condition have widespread tender or trigger points and may have symptoms associated with chronic fatigue syndrome.1 Individuals are diagnosed by a process of elimination and may require multiple tests of endocrine and immunity systems to rule out other disorders. These individuals commonly receive treatment for depression, which may also benefit from an exercise program.2 However, they find many activities difficult to perform due to diffuse, persistent pain. Individuals limit their activities in an effort to decrease or control their ongoing symptoms.
Benefits of an Exercise Program for a Client With Fibromyalgia
|Increased levels of endorphins ||Increased cortisol levels |
|Increased metabolic rate ||Increased lean-tissue mass |
|Improved sleep patterns ||Decreased pain and fatigue |
Comorbidities to Consider
Keys to Examination of Clients
Perform baseline testing of clients' mobility, posture, and flexibility before prescribing an exercise program.
Discuss with clients their beliefs and experience with exercise, as they may be reluctant to start an exercise program. Discuss with them the likelihood that increasing levels of activities will be associated with increased pain severity and fatigue.
Recommended Baseline Testing of Fitness Levels
Use the 6-minute walk test as a recommended baseline of aerobic fitness and tolerance to exercise.3
Employ the global pain rating scale, tender point count, and the Fibromyalgia Impact Questionnaire to establish a baseline of muscle pain symptoms.2,4
Type: Aerobic activities, aquatic therapies, weight training
Intensity: Begin with very low levels
Duration: Short bouts of 2–5 minutes, with rest periods
Frequency: Three to four times per week
Aerobic exercise is considered the most important element of an exercise program for individuals with fibromyalgia, but strengthening exercises have also been found to have similar effects for changes in physical and psychological parameters.5,6,7 Aerobic exercises should be started at levels just below clients' capacity, and progressions should be gradual. Individuals may need to start with 2- to 5-minute bouts at low intensities. Aquatic exercise in warm pools (>85°F) is a highly recommended form of exercise.2 Individuals will find muscle-stretching routines and movement therapies, such as t'ai chi and Pilates, a good start to a regular exercise program.3,8 Progressing intensities to 60% to 75% of age-adjusted maximum heart rate is recommended, but clients should be taught perceived exertion methods for determining the intensity of their exercise ...